A Day in the Life

By Theresa Everline

Anne Ades, MD, MSEd, considers simulation training an ethical imperative that helps students perform their best. When Anne Ades, MD, MSEd, was a medical resident, she learned how to intubate patients by practicing on marginally anaesthetized ferrets. She now serves as Medical Co-Director of CHOP’s Center for Simulation, Advanced Education and Innovation. The Sim Center prepares clinicians to provide the safest, most efficient care to children and promotes a culture of learning — all while using computerized medical manikins that mimic human anatomy. This is a day in her life.

6:15 a.m. Feeds her cats and makes coffee that she’ll drink during the drive to CHOP.

7:45 a.m. In a room on the second floor of CHOP’s Philadelphia hospital, prepares for a session simulating newborn resuscitation. Turns on the infant manikin, which moves its arms slightly and lets out a soft cry.

8 a.m. The eight participants include a respiratory therapist and a nurse from the Harriet and Ronald Lassin Newborn/Infant Intensive Care Unit. They practice bag mask ventilation and chest compressions, which require group choreography to keep everyone in optimal position.

8:25 a.m. Controls the manikin’s response, such as its heart rate, while the participants simulate a scenario in which the baby must be stabilized.

8:45 a.m. Sits in a circle with the participants to debrief, touching on topics such as communication, teamwork and medical interventions. “This discussion is so helpful,” says one student. Afterward, Ades explains, “We help them deal with stress, but we don’t want them too stressed, because then all they remember is the stress.” She considers simulation training an ethical imperative, with students learning how to perform their best and manage vulnerability.

9 a.m. Meets with the Sim Center core team, including Medical Co-Director Akira Nishisaki, MD, MSCE, and Program Director Roberta Hales, RRT. One goal of the center’s work is to help others become better educators. The team is happy to see that in a survey they gave to people who were taught to conduct simulation, the majority reported having applied the skills they learned, such as teamwork, facilitation and debriefing.

10:30 a.m. Alerts a newborn stabilization team — which involves anesthesia, surgery and neonatology — that the next day they will be simulating an upcoming real-life procedure: In two days, a 28-weeks-gestation baby who has a large tailbone tumor is scheduled to be delivered and then the tumor removed. “We simulate complex cases where people have overlapping expertise, so we can plan for who does what.”

Noon Eats lunch while reviewing the prior month’s work with about 20 Sim Center colleagues. The list includes sessions at CHOP’s Care Network locations in Bryn Mawr and Brandywine Valley. “Most of the time, we come to you, you don’t come to us. We aim to replicate real events.”

1:30 p.m. Together with staff from Facilities and from Human Factors — engineers who study the interaction between workers, equipment and the environment — plans the design of physical spaces in the New Patient Tower, which will begin construction in 2024. Full-size mock rooms will soon be built to test the placement of equipment, ergonomics, sight lines — even how specific doors function when moving patients in and out of rooms.

Ades helps trainee Kristen Coletti, MD, insert a chest tube into an infant-size manikin and intubate a manikin the size of a 28-week-old preemie. 3 p.m. Conducts the first of two sim sessions with CHOP fellows. The patient is now an infant with severe RSV (respiratory syncytial virus). Quickly, the manikin’s vital signs worsen. The fellows decide to intubate, but the manikin has an obstruction in its airway, so the tube won’t go in. The fellow in charge decides, “We need to call the airway emergency team,” and the simulation ends.

3:40 p.m. Sits with the fellows in a circle to debrief. “I felt the team communicated well,” one observes. “It’s hard when you feel there’s not more to do,” admits another.

4 p.m. Runs the second session. The outcome is similar — they call the airway emergency team — but the path to it varies from the first group’s. “Sometimes we do this three times, and each time it plays out differently.”

5 p.m. Catches up on emails before the drive home.

6 p.m. The cats get fed. Works out on her pandemic-bought rowing machine. Eats dinner with her partner, Jack, and watches some TV.